Heart related disorders resulting from lack of coronary circulation, such as a heart attack, have been and likely will continue to be the most common cause of death in the industrialized world. An estimated 3-4 million Americans suffer from heart attack per year. Approximately half of the heart attacks are "silent" meaning they are not felt by patients. Half of the patients who sustain heart attacks die prior to arrival to hospital. The present innovation, therefore, relates to early detection and long term monitoring of heart related disorders.
There are any number of patients who are suspected of heart disease. As the effects of aging manifest in the population in general, certain heart ailments will sometimes appear suddenly, or will sometimes develop slowly over a period of time. Beginning at about age 50 for men and age 60 for women, it is usually desirable to build a data base line by conducting an annual physical which includes the collection of at least some heart data. A resting electrocardiogram (EKG) typically done with three leads provides modest data. It is much more desirable to obtain data with a twelve lead EKG test, and even better to obtain the test data on a stress test utilizing a treadmill. Any number of specific protocols have been developed for conducting the stress treadmill test and obtaining data from it. Technically, the heart attack is often defined as myocardial infarction (MI) and typically involves a localized shortage of oxygen or the formation of a regionalized blood clot which attributes to a shortage of oxygen in some portion of the heart. These conditions are known as ischemia and thrombosis. With age and perhaps a loss of cardiovascular strength, a patient may develop difficulties which can be observed b y listening, but the better approach is the collection of data with a multiple lead EKG test. The multiple lead approach simply gathers so much more data that it is much easier to measure both an initial state of affairs and to make prompt appraisal of the condition of the patient.
In any number of situations, heart patients may have a series of difficulties over time. With each small or large difficulty, there will be some change in the base line conditions for that patient. While some measure of recovery can be had, the prevailing or normal circumstances for that patient will be, in some fashion, different than they were when that patient was just becoming an adult. So to speak, each event may define or redefine the base line circumstances.
In other instances, no base line data will be available because the patient will be suddenly struck with difficulties or an ailment with results something less than fatal. Nevertheless, the ailment impacts the patient, perhaps requiring treatment for a day or two and some hospitalization. Consider, for example. a middle aged person who has a modest chest pain and is immediately admitted to a hospital for observation. They may leave the hospital the next day, perhaps with medications and with warnings, perhaps dire or otherwise, demanding a change in lifestyle including a new diet, reduction of stress, and other changes in lifestyle. Instructions to return to the doctor in a few days represents some sort of cold comfort which they carry with them. The return to the doctor is normally for the purpose of simply monitoring their condition. Usually, the medical personnel in charge of treatment have a fairly safe estimation of risk and health maintenance that are necessary for the patient. The patient, however, is normally struck with fear and apprehension. Moreover, for many types of ailments, merely going to a doctor's office and especially doing to a hospital prompts a high level of internalized stress which is manifest in the cardiovascular system. Some people become highly agitated which is reflected in an elevated pulse rate, perhaps shallow breathing and other common symptoms of stress. These make the return visits to the doctor somewhat problematic. It makes it difficult at any point in time for medical intervention in that the patient is asked to calm their stress and lay aside the worries and anxieties, both real and imagined, of the next episode. They always question whether the next episode will be small or large, sudden or immediate. It is fair to say that this possibly short term stress and anxiety affects the collection of the cardiovascular data, and may even mask or otherwise perturb more permanent cardiovascular indicators.
Interestingly, the collection of cardiovascular data on a long term basis enables the patient to return in some fashion to a normative lifestyle. Stress and related anxiety are generally reduced. Furthermore, not hearing the truth somehow avoids the bad news, and subject to this thinking, many patients are rebellious about return to the doctor and will not return. They reason along the lines that the knowledge will be frightening so that if they do not know, a cardiovascular abnormality will somehow not harm them. The dangers in this attitude are conspicuous.
A relatively high level of anxiety is manifest by a patient who is required to undergo a stress treadmill test. Not only is there physical stress in the sense that muscles are pushed to the limit, but there is simply the anxiety that this is a test not required of healthy people. By contrast, when a patient is monitored day and night, they are compelled to forget the monitoring. Monitored data will, therefore, reflect long term conditions and not be perturbed by short term, testing related emotional effects.
The monitoring of a patient around the clock, however, is clumsy because of the nature of the equipment. One common monitoring system involves the Halter test. This test involves recording, in a small cassette recorder, heart data which is derived from a few EKG leads where the data are recorded on a cassette. Typically, this test is applied to a patient for only 24 hours. One aspect of the test that is burdensome is that the patient must report back to the doctor's office, return the equipment and deliver the cassette. Thereafter, the cassette has to be played back on a magnetic tape deck, signals presented on a screen, and the signals inspected on the screen. In the past, this data processing has been done by hand, meaning a technician must sit and watch a replay of 24 hours of heartbeats. With a pulse of 60 beats per minute, this totals 86,400 beats while it goes to 100,800 beats at 70 beats per minute. This is a fair amount of data to carefully examine. Ordinarily, that is done by hand or scanning.
Another monitoring system that has found favor is used for patients located in a hospital coronary care unit (CCU) and also to those who are postoperative. Monitoring while in the CCU is self-explanatory. It provides instantaneous data to the medical staff for emergency help dependent on the telemetry signals and data from the patient. Monitoring in a postoperative mode during recovery typically involves daily or near daily attendance of the recovering patient to a hospital located exercise room. It is not uncommon for patients in this status to really want to change their lifestyle. Habits die hard! After not exercising for 20 or 30 years, after eating almost anything that they desired for the same time interval, and after accumulating excess weight, the patient then gets something of a scare. from the cardiovascular episode. Patients then immediately seek a new lifestyle that will fix up the accumulated problems and damages suffered in their body after 20 or 30 years of neglect. In a particular instance, they may go to an exercise facility maintained by the nearby hospital. In the exercise room, they typically will check in, be fitted with a frequency modulated (FM) telemetry system, and then will be instructed to exercise at a very gentle and slow pace on various machines under the watchful eye of medical personnel. The personnel not only watch the patient visually through a window, they also watch the FM telemetry signals received from the patient during the exercise session. Assuming that the patient is faithful to the program, they will build up some level of performance on the machines thereby strengthening their body and strengthening their heart in a post recovery mode. It is not uncommon for patients to continue this for many weeks always under the watchful eye of the attendant personnel when coupled with them via FM telemetry. However, there comes a day when the patients have to exert themselves away from the medical facility, away from the watchful eye of medical personnel who have by this time become very familiar with the patient's base line conditions and without the comfort of the telemetry system. Chores just as simple as mowing the lawn, shoveling snow from the sidewalk, or bringing in groceries can bean exertion of an unknown level, likely to cause a raised pulse, and possibly subject to stress as a result of the missing comfort provided by the FM telemetry and attendant medical personnel. That fear itself can add stress to the patient prompting even higher levels of pulse rate, shallow breathing, etc. All of these factors occur when the recovering patient forgets and undertakes a task or meets a challenge away from the safety of the controlled exercise routine. Another aspect of heart care is absence of noticeable pain. The pain in some people is minimal because there are fewer nerves in the heart region compared with the face or hands. Over time, cumulative small MI events may collectively damage the heart silently, i.e., with no alarm.
By contrast, it is most desirable that recovering patients be discharged to undertake a lifestyle which is substantially free of medical intervention. In attempts to rebuild strength, they are encouraged to undertake walking programs and other exercise regimens which build in difficulty over time. While the difficulty may build, the patient must have the courage to jump into that program knowing that controlled physical exercise is the best mode of recovery. That, however, is hard to do without medical supervision. That is difficult and a fearful thing in general terms. Monitoring of the data generated by a patient throughout the day in a post recovery mode is not possible because it would otherwise require t h e patient to simply live in the hospital or in the adjunct exercise facility. That is unwieldy and not reasonably calculated to restore the patient to "normal" living as defined by the life of that patient. The goal, it would seem, is to restore the patient to a normal job situation with normal exercise, but to increase and enhance the exercise level so that the patient can recover to the level he or she had before the episode and also to hopefully increase their strength by a new lifestyle featuring appropriate exercise. This can be seen only by observation of the patient over weeks, or preferably over many months, so that the patient can be restored to an effective status.